scholarly journals Prognostic Marker for Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Analysis of Diffusing Capacity of the Lung for Carbon Monoxide (DLCO) and Forced Expiratory Volume in One Second (FEV1)

2021 ◽  
Author(s):  
Juwhan Choi ◽  
Jae Kyeom Sim ◽  
Jee Youn Oh ◽  
Young Seok Lee ◽  
Gyu Young Hur ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Length Of Hospital Stay ◽  
Forced Expiratory Volume ◽  
Curve Analysis ◽  
Chronic Obstructive ◽  
Diffusing Capacity ◽  
Roc Curve Analysis ◽  
Obstructive Pulmonary Disease

Abstract Background: It is important to assess the prognosis and classify patients in chronic obstructive pulmonary disease (COPD) and acute exacerbation of COPD (AECOPD) treatment. Recently, it was suggested that diffusing capacity of the lung for carbon monoxide (DLCO) should be added to multidimensional tools for assessing COPD. This study aimed to compare the DLCO and forced expiratory volume in one second (FEV1) to identify better prognostic factors for admitted patients with AECOPD.Methods: We retrospectively analyzed 342 patients with AECOPD receiving inpatient treatment. We classified 342 severe AECOPD events using DLCO and FEV1. We defined the prognostic factors of severe AECOPD as the length of hospital stay, mortality in hospital, experience of mechanical ventilation, and experience of intensive care unit (ICU) care. We analyzed the prognostic factors by multivariate analysis using logistic regression. In addition, we conducted a correlation analysis and receiver operating characteristic (ROC) curve analysis.Results: In univariate and multivariate analyses, DLCO was shown to predict mortality rate (odds ratio = 4.408; 95% confidence interval, 1.070–18.167; P = 0.040), experience of ventilator (odds ratio = 2.855; 95% confidence interval, 1.216–6.704; P = 0.016) and ICU (odds ratios = 2.685; 95% confidence interval, 1.290–5.590; P = 0.008). However, there was no statistically significant difference in mortality rate when using FEV1 classification (P = 0.075). In the correlation analysis, both DLCO and FEV1 showed a negative correlation with length of hospital stay. The correlation rate was more pronounced in the DLCO (DLCO; B = -0.103, P < 0.001) (FEV1; B = -0.075, P = 0.007). In addition, DLCO showed better predictive ability than FEV1 in ROC curve analysis. The area under the curve (AUC) of DLCO was greater than 0.68 for all prognostic factors, and in contrast, the AUC of FEV1 was less than 0.68.Conclusion: DLCO was likely to be as good as or better prognostic marker than FEV1 in severe AECOPD.

scholarly journals Prognostic Marker for Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Analysis of Diffusing Capacity of the Lung for Carbon Monoxide (DLCO) and Forced Expiratory Volume in One Second (FEV1)

2020 ◽  
Author(s):  
Juwhan Choi ◽  
Jae Kyeom Sim ◽  
Jee Youn Oh ◽  
Young Seok Lee ◽  
Gyu Young Hur ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Length Of Hospital Stay ◽  
Forced Expiratory Volume ◽  
Curve Analysis ◽  
Chronic Obstructive ◽  
Diffusing Capacity ◽  
Roc Curve Analysis ◽  
Obstructive Pulmonary Disease

Abstract Background: It is important to assess the prognosis and classify patients in chronic obstructive pulmonary disease (COPD) and acute exacerbation of COPD (AECOPD) treatment. Recently, it was suggested that diffusing capacity of the lung for carbon monoxide (DLCO) should be added to multidimensional tools for assessing COPD. This study aimed to compare the DLCO and forced expiratory volume in one second (FEV1) to identify better prognostic factors for admitted patients with AECOPD.Methods: We retrospectively analyzed 342 patients with AECOPD receiving inpatient treatment. We classified 342 severe AECOPD events using DLCO and FEV1. We defined the prognostic factors of severe AECOPD as the length of hospital stay, mortality in hospital, experience of mechanical ventilation, and experience of intensive care unit (ICU) care. We analyzed the prognostic factors by multivariate analysis using logistic regression. In addition, we conducted a correlation analysis and receiver operating characteristic (ROC) curve analysis.Results: In univariate and multivariate analyses, DLCO was shown to predict mortality rate (odds ratio = 4.408; 95% confidence interval, 1.070–18.167; P = 0.040), experience of ventilator (odds ratio = 2.855; 95% confidence interval, 1.216–6.704; P = 0.016) and ICU (odds ratios = 2.685; 95% confidence interval, 1.290–5.590; P = 0.008). However, there was no statistically significant difference in mortality rate when using FEV1 classification (P = 0.075). In the correlation analysis, both DLCO and FEV1 showed a negative correlation with length of hospital stay. The correlation rate was more pronounced in the DLCO (DLCO; B = -0.103, P < 0.001) (FEV1; B = -0.075, P = 0.007). In addition, DLCO showed better predictive ability than FEV1 in ROC curve analysis. The area under the curve (AUC) of DLCO was greater than 0.68 for all prognostic factors, and in contrast, the AUC of FEV1 was less than 0.68.Conclusion: DLCO was likely to be as good as or better prognostic marker than FEV1 in severe AECOPD.

scholarly journals Pulmonary restriction predicts long-term pulmonary impairment in people with HIV and tuberculosis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sara C. Auld ◽  
Hardy Kornfeld ◽  
Pholo Maenetje ◽  
Mandla Mlotshwa ◽  
William Chase ◽  
...  
Keyword(s):  
Lung Function ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Logistic Regression Models ◽  
Pulmonary Impairment ◽  
Mixed Pattern

Abstract Background While tuberculosis is considered a risk factor for chronic obstructive pulmonary disease, a restrictive pattern of pulmonary impairment may actually be more common among tuberculosis survivors. We aimed to determine the nature of pulmonary impairment before and after treatment among people with HIV and tuberculosis and identify risk factors for long-term impairment. Methods In this prospective cohort study conducted in South Africa, we enrolled adults newly diagnosed with HIV and tuberculosis who were initiating antiretroviral therapy and tuberculosis treatment. We measured lung function and symptoms at baseline, 6, and 12 months. We compared participants with and without pulmonary impairment and constructed logistic regression models to identify characteristics associated with pulmonary impairment. Results Among 134 participants with a median CD4 count of 110 cells/μl, 112 (83%) completed baseline spirometry at which time 32 (29%) had restriction, 13 (12%) had obstruction, and 9 (7%) had a mixed pattern. Lung function was dynamic over time and 30 (33%) participants had impaired lung function at 12 months. Baseline restriction was associated with greater symptoms and with long-term pulmonary impairment (adjusted odds ratio 5.44, 95% confidence interval 1.16–25.45), while baseline obstruction was not (adjusted odds ratio 1.95, 95% confidence interval 0.28–13.78). Conclusions In this cohort of people with HIV and tuberculosis, restriction was the most common, symptomatic, and persistent pattern of pulmonary impairment. These data can help to raise awareness among clinicians about the heterogeneity of post-tuberculosis pulmonary impairment, and highlight the need for further research into mediators of lung injury in this vulnerable population.

Distinctive patterns of pulmonary function change according to baseline lung volume and diffusing capacity

2020 ◽  
Vol 24 (6) ◽  
pp. 597-605
Author(s):  
J. Kang ◽  
Y-M. Oh ◽  
J-H. Lee ◽  
E. K. Kim ◽  
S. Y. Lim ◽  
...  
Keyword(s):  
South Korea ◽  
Pulmonary Function ◽  
Lung Volume ◽  
Forced Expiratory Volume ◽  
Random Coefficients ◽  
Chronic Obstructive ◽  
Diffusing Capacity ◽  
Obstructive Pulmonary Disease ◽  
Function Change ◽  
Physiological Markers

SETTING: Multicentre retrospective study in South Korea.OBJECTIVE: To longitudinally evaluate changes in lung volume and diffusing capacity for carbon monoxide (DLCO) with forced expiratory volume in 1 sec (FEV1).DESIGN: A total of 155 patients with chronic obstructive pulmonary disease (COPD), whose pulmonary function parameters were measured annually for 5 years, were selected from a prospective cohort in South Korea. A random coefficients model was used to estimate mean annual FEV1, lung volume parameter and DLCO change rates.RESULTS: Patients were classified into four groups based on baseline DLCO and residual volume/total lung capacity (RV/TLC) measurements. The annual FEV1 decline rate was greater in patients with low DLCO than in those with normal DLCO, with the greatest decline occurring in patients with low DLCO and normal RV/TLC. RV and RV/TLC declined in patients with high RV/TLC, whereas these increased in patients with normal RV/TLC. DLCO decreased longitudinally in all four groups, with the greatest decline occurring in patients with normal DLCO and normal RV/TLC.CONCLUSIONS: Different subgroups of patients with COPD exhibited distinctive pulmonary function change patterns. Baseline DLCO and RV/TLC may be used as physiological markers to predict long-term changes in pulmonary function.

scholarly journals Integrated palliative care networks from the perspectives of patients: A cross-sectional explorative study in five European countries

2018 ◽  
Vol 32 (6) ◽  
pp. 1103-1113 ◽  
Author(s):  
Marlieke den Herder-van der Eerden ◽  
Anne Ebenau ◽  
Sheila Payne ◽  
Nancy Preston ◽  
Lukas Radbruch ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Palliative Care ◽  
Confidence Interval ◽  
Pulmonary Disease ◽  
Odds Ratio ◽  
Healthcare Professionals ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Lower Odds

Background: Although examining perspectives of patients on integrated palliative care organisation is essential, available literature is largely based on administrative data or healthcare professionals’ perspectives. Aim: (1) Providing insight into the composition and quality of care networks of patients receiving palliative care and (2) describing perceived integration between healthcare professionals within these networks and its association with overall satisfaction. Design: Cross-sectional explorative design. Setting/participants: We recruited 157 patients (62% cancer, 25% chronic obstructive pulmonary disease, 13% chronic heart failure, mean age 68 years, 55% female) from 23 integrated palliative care initiatives in Belgium, Germany, the United Kingdom, Hungary and the Netherlands. Results: About 33% reported contact with a palliative care specialist and 48% with a palliative care nurse. Relationships with palliative care specialists were rated significantly higher than other physicians ( p < 0.001). Compared to patients with cancer, patients with chronic obstructive pulmonary disease (odds ratio = 0.16, confidence interval (0.04; 0.57)) and chronic heart failure (odds ratio = 0.11, confidence interval (0.01; 0.93)) had significantly lower odds of reporting contact with palliative care specialists and patients with chronic obstructive pulmonary disease (odds ratio = 0.23, confidence interval (0.08; 0.71)) had significantly lower odds of reporting contact with palliative care nurses. Perceptions of main responsible healthcare professionals or caregivers in patient’s care networks varied across countries. Perceived integration was significantly associated with overall satisfaction. Conclusion: Palliative care professionals are not always present or recognised as such in patients’ care networks. Expert palliative care involvement needs to be explicated especially for non-cancer patients. One healthcare professional should support patients in understanding and navigating their palliative care network. Patients seem satisfied with care provision as long as continuity of care is provided.

scholarly journals Physical Activity in Older Cancer Survivors: What Role Do Multimorbidity and Perceived Disability Play?

2020 ◽  
Vol 28 (2) ◽  
pp. 311-319 ◽  
Author(s):  
Shirley M. Bluethmann ◽  
Wayne Foo ◽  
Renate M. Winkels ◽  
Scherezade K. Mama ◽  
Kathryn H. Schmitz
Keyword(s):  
Physical Activity ◽  
Confidence Interval ◽  
Cancer Survivors ◽  
Odds Ratio ◽  
Age Groups ◽  
Chronic Obstructive ◽  
Behavioral Risk ◽  
Obstructive Pulmonary Disease ◽  
Exercise Interventions ◽  
Perceived Disability

Purpose: (a) To describe the relationship of multimorbidity and physical activity (PA) in cancer survivors and (b) to explore perceived disability and PA in middle-aged and older survivors. Methods: The authors analyzed the data from cancer survivors (N = 566), identified using the Pennsylvania Cancer Registry, who responded to a Behavioral Risk Factor Surveillance System-derived questionnaire. They created age groups (e.g., 45–54 years, 55–64 years, 65–74 years, and 75 years and older) and calculated a composite score of eight common comorbidities (e.g., chronic obstructive pulmonary disease, heart disease) to assess multimorbidity. Logistic regression was used to estimate the association of demographic and behavioral/clinical risk factors (e.g., multimorbidity, perceived disability, body mass index) with PA. Results: Most respondents were females (62%), older (mean age = 68 years) and represented diverse cancer sites, including breast (n = 132), colorectal (n = 102), gynecologic (n = 106), prostate (n = 111), and lung (n = 80). PA participation was mixed; 44% of survivors reported achieving >150 min of aerobic PA, but half of lung and 37% of gynecologic survivors reported no PA (0 min/week). Higher multimorbidity (odds ratio = 0.82, confidence  interval [0.69, 0.98], p < .05), obesity (odds ratio = 0.51, confidence  interval [0.30, 0.86], p < .05), and perceived disability (odds ratio = 0.49, confidence  interval [0.32, 0.77], p < .001) were negatively associated with PA participation. Strength training was suboptimal across all survivors. Conclusion: Most older survivors experienced comorbid conditions, and this was associated with less PA. Survivors who perceived themselves as disabled or who were obese were half as likely as others to participate in PA. This suggests an increasing need to address both physical and psychological limitations in designing PA interventions for real-world needs. Exercise interventions that address the unique needs of older survivors for multimorbidity, obesity, and perceived disability may strengthen opportunities for PA.

Chronic Obstructive Pulmonary Disease and Symptoms Related to Depression in Elderly Persons

1995 ◽  
Vol 76 (1) ◽  
pp. 287-297 ◽  
Author(s):  
Raimo Isoaho ◽  
Pekka Laippala ◽  
Timo Keistinen ◽  
Sirkka-Liisa Kivelä
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Confidence Interval ◽  
Pulmonary Disease ◽  
Odds Ratio ◽  
Marital Relationship ◽  
Primary Care Providers ◽  
Chronic Obstructive ◽  
Elderly Persons ◽  
Obstructive Pulmonary Disease ◽  
Female Patients

In a community study, 61 men and 21 women with mild to severe chronic obstructive pulmonary disease (COPD) were compared with age- and sex-matched controls (183 men and 63 women) to identify and analyze the associations between the occurrence of COPD and depressive symptoms, the occurrence of previous or current psychiatric disorders, the use of psychiatric drugs, and satisfaction with one's marital relationship. In men, no associations between COPD and the above factors were found. More women with COPD than controls reported feelings of dissatisfaction with life. The female patients also tended to be less satisfied with their marital relationship than the controls. Multivariate analysis showed that this disease in women was associated with disability (odds ratio 3.25, 95% confidence interval 1.17–9.06), feelings of dissatisfaction with life (odds ratio 3.56, 95% confidence interval 1.23–10.34), and low satisfaction with one's marital relationship (odds ratio 3.23, 95% confidence interval 1.10–9.47). These results seem to suggest that elderly female patients with COPD have more mental health problems than male patients and these will require more attention from the primary care providers.

Association Between Transient Opioid Use and Short-Term Respiratory Exacerbation Among Adults With Chronic Obstructive Pulmonary Disease: A Case-Crossover Study

2019 ◽  
Vol 188 (11) ◽  
pp. 1970-1976 ◽  
Author(s):  
Yiran Rong ◽  
John P Bentley ◽  
Gerald McGwin ◽  
Yi Yang ◽  
Benjamin F Banahan ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Confidence Interval ◽  
Pulmonary Disease ◽  
Odds Ratio ◽  
Chronic Obstructive ◽  
Administrative Claims ◽  
Opioid Use ◽  
Short Term ◽  
Obstructive Pulmonary Disease ◽  
Case Crossover

Abstract The association of historical opioid use with health care use and death among patients with chronic obstructive pulmonary disease (COPD) has been tested. Using Mississippi Medicaid data, we examined the association of transient or short-term opioid use and acute respiratory exacerbations among adults with COPD. We used a case-crossover design and 2013–2017 Mississippi Medicaid administrative claims data. A total of 1,972 qualifying exacerbation events occurred in 1,354 beneficiaries. The frequency and dose of opioid exposure in the 7 days before the exacerbation were examined and compared with the opioid exposure in 10 control windows, each 7 days long, before the exacerbation. Adjusted odds ratios were estimated using conditional logistic regression models to estimate the risk of opioid use on exacerbations after accounting for use of bronchodilators, corticosteroids, benzodiazepines, and β-blockers. Overall, opioid exposure in the 7 days before an exacerbation was significantly associated with acute respiratory exacerbation (odds ratio = 1.81; 95% confidence interval: 1.60, 2.05). Each 25-mg increase in morphine equivalent daily dose was associated with an 11.2% increase in the odds of an acute respiratory exacerbation (odds ratio = 1.11; 95% confidence interval: 1.04, 1.20). Transient use of opioids was significantly associated with acute respiratory exacerbation of COPD.

Baduanjin exercise for chronic obstructive pulmonary disease: an updated systematic review and meta-analysis

2020 ◽  
Vol 34 (8) ◽  
pp. 1004-1013
Author(s):  
Ailing Cao ◽  
Fanchao Feng ◽  
Li Zhang ◽  
Xianmei Zhou
Keyword(s):  
Quality Of Life ◽  
Chronic Obstructive Pulmonary Disease ◽  
Confidence Interval ◽  
Pulmonary Disease ◽  
Forced Expiratory Volume ◽  
Mean Difference ◽  
Walking Distance ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Objective: To objectively evaluate the effectiveness of Baduanjin exercise on cardiopulmonary function and quality of life in chronic obstructive pulmonary disease patients. Data sources: Articles published in PubMed, EMBASE, China National Knowledge Infrastructure Database, the Cochrane Library, Wanfang Database, and China Biological Medicine Database from inception to March 2020. Review Method: Articles on randomized controlled trials about Baduanjin exercise for the treatment of chronic obstructive pulmonary disease were identified. Cochrane handbook was applied to assess the quality of included trials. Stata (version 14.0) and Review Manager (version 5.3) were employed for data analysis. Mean difference with 95% confidence intervals were calculated for pulmonary function, 6-minute walking distance, and the quality of life. Results: Thirty-one randomized controlled trials including 3045 patients were included. The result of meta-analysis indicated that comparing with any other type of treatment alone, Baduanjin exercise combined other type of treatment revealed well efficacy in improving exercise capability on 6-minute walking distance (mean difference = 43.83, 95% confidence interval (29.47, 58.20), P < 0.00001), forced expiratory volume in 1 second (mean difference = 0.23, 95% confidence interval (0.15, 0.31), P < 0.00001), forced volume vital capacity (mean difference = 0.19, 95% confidence interval (0.08, 0.30), P = 0.0007), the ratio of forced expiratory volume in the first second to forced vital capacity (mean difference = 3.85, 95% confidence interval (2.19, 5.51), P < 0.00001), and the quality of life in chronic obstructive pulmonary disease patients regarding the St. George respiratory questionnaire (mean difference = –7.71, 95% confidence interval (–10.54, –4.89), P < 0.00001) and chronic obstructive pulmonary disease assessment test (mean difference = –2.56, 95% confidence interval (–4.13, –1.00), P = 0.001). Conclusions: Baduanjin exercise could improve exercise capacity, pulmonary function, and quality of life for patients with chronic obstructive pulmonary disease.

scholarly journals Characterisation of gas exchange in COPD with dissolved-phase hyperpolarised xenon-129 MRI

Thorax ◽  
2020 ◽  
pp. thoraxjnl-2020-214924
Author(s):  
Lukasz Myc ◽  
Kun Qing ◽  
Mu He ◽  
Nicholas Tustison ◽  
Zixuan Lin ◽  
...  
Keyword(s):  
Blood Cells ◽  
Forced Expiratory Volume ◽  
Chest Ct ◽  
Chronic Obstructive ◽  
Gas Transfer ◽  
Diffusing Capacity ◽  
Obstructive Pulmonary Disease ◽  
Diffusion Capacity ◽  
Capacity Limitations ◽  
Dissolved Phase

To investigate whether hyperpolarised xenon-129 MRI (HXeMRI) enables regional and physiological resolution of diffusing capacity limitations in chronic obstructive pulmonary disease (COPD), we evaluated 34 COPD subjects and 11 healthy volunteers. We report significant correlations between airflow abnormality quantified by HXeMRI and per cent predicted forced expiratory volume in 1 s; HXeMRI gas transfer capacity to red blood cells and carbon monoxide diffusion capacity (%DLCO); and HXeMRI gas transfer capacity to interstitium and per cent emphysema quantified by multidetector chest CT. We further demonstrate the capability of HXeMRI to distinguish varying pathology underlying COPD in subjects with low %DLCO and minimal emphysema.

Sign in / Sign up

Export Citation Format

Share Document